Countering Covid-19: Centre and states marshal their resources for a quick and effective response

There have been 34 confirmed cases, including 16 Italian tourists, in India so far but no deaths.

A doctor locks the door of a special ward set aside for possible COVID-19 patients at a government hospital in Jammu. Authorities are scrambling to ready a beleaguered medical system for a potential surge of patients.

How well an administration reacts to a health emergency may not entirely be clear from the website of its health department. But in Kerala’s case, it is an accurate reflection of the state’s deft handling of the novel coronavirus disease, or Covid-19.

The homepage of Kerala’s health portal is rich with information related to coronavirus, including daily district-wise data on how many people are under observation. There is a detailed list of risk factors for fliers — including where they sat and where an infected person did — and information on the discharge criteria for those who have come from various countries. The state has set up as many as 18 teams — including for surveillance and for ambulance management — in the state coronavirus control room.

Kerala is a welcome anomaly in an otherwise inadequate public-healthcare system in India. The state earned plaudits for the manner in which it tackled the Nipah virus outbreak in 2018. So Kerala’s response to Covid-19 is hardly surprising. The first three Covid-19 cases in India were reported in Kerala in January-February, but they were all cured. There have been no more cases in the state.

As concerns over the spread of Covid-19 grow stronger across the country, even other states and the Centre are throwing their weight behind containing it. There have been 34 confirmed cases, including 16 Italian tourists, in India so far but no deaths. On Saturday, Prime Minister Narendra Modi took stock of the situation and the steps taken by the government.

The Union government on February 3 set up a group of ministers (GoM) to monitor the situation. Led by Health Minister Harsh Vardhan, the GoM — which also consists of the external affairs and civil aviation ministers, and junior ministers of health, home and shipping — has met five times till now. Besides the ministries, agencies such as the National Centre for Disease Control and the National Pharmaceutical Pricing Authority are also part of the government’s efforts.

A wall at a government hospital in Kolkata displays COVID-19 helpline number. State governments have deployed resources from multiple departments to disseminate information regarding the virus.“Even though the WHO (World Health Organization) has not declared Covid-19 a pandemic, it has asked countries to remain prepared. India initiated the required preparedness and action at the field level on January 17, much before the advice from the WHO,” says Vardhan.

Exports of critical items such as personal protective equipment and N95 masks have been restricted to ensure their availability in India.

Cabinet Secretary Rajiv Gauba has held 15 review meetings with various ministries since January 27. On March 6, the health ministry and the WHO organised a training session that was attended by 280 health officials from all states and from the hospitals of the railways, defence and paramilitary forces. Video conferences are also being held with states every other day, both to train officials and to take stock of the situation.

Health Secretary Preeti Sudan has deputed more than 10 joint secretaries to assess the preparedness of states and Union territories. But state officials do not want meetings to be counter-productive. “During a crisis like this, you cannot allow meetings to take up a lot of your time. That is why we combine meetings and interact mostly on WhatsApp groups and conference calls on the move,” says K Kolandaswamy, director of public health in Tamil Nadu.

The Covid-19 outbreak began in Wuhan in China’s Hubei province in December and has since spread to 88 countries and territories. There have been over 98,000 confirmed cases — 82% of that in China alone — and 3,380 deaths, with over 3,000 just in China, according to the WHO. Believed to have been transmitted from bats through other animals to humans, the virus spreads when a person comes in contact with small droplets from an infected person’s nose or mouth and then touches her own eyes, nose or mouth.

That is why polio-awareness workers in Uttar Pradesh, the country’s most populous state, have been wearing masks and maintaining a distance of 1.5 metres while making enquiries at homes throughout Agra, a favourite among local and foreign tourists. The exercise is being carried out to reach all those who possibly had contact with an infected person. More than 50,000 houses have already been surveyed, says Mukesh Vats, Agra’s chief medical officer. “We decided to deploy polio abhiyan workers as they are aware of their localities.” A man who tested positive for Covid-19 had travelled to Agra to meet his relatives. They have all been quarantined.

In Rajasthan, a rapid action team has been set up to trace those who came in contact with Italian tourists in Jhunjhunu, Jodhpur, Jaipur, Jaisalmer, Udaipur and Bikaner, according to state health minister Raghu Sharma. Italy has become Europe’s coronavirus hotspot. Besides the health department, other arms of the government are being drafted into the fight against Covid-19. Sachin Pilot, deputy chief minister of Rajasthan, says, “All departments in the state, including local bodies, are taking precautions to stop its spread. For example, my own department — the rural development — has been engaged in making villagers aware of the dos and don’ts of the disease.”

Medical staff wear protective masks at an isolation ward at the Sardar Vallabhbhai Patel Institute of Medical Sciences in Ahmedabad.However, relying just on government hospitals would not be enough if the number of infected people was to multiply. And that is why states such as Delhi, Tamil Nadu and Maharashtra are turning to private or trust-owned hospitals to meet the shortfall in capacity. Telangana has announced that it has the option of using as isolation wards the 40,000 two-bedroom houses it plans to hand over to poor families, in addition to the 3,000 beds it has set aside in five public hospitals.

India has quickly increased the number of labs that can test samples for Covid-19, from 15 a few days ago to 51 now, with Pune’s National Institute of Virology being the nodal lab. As of March 6, over 4,000 samples had been tested in India, according to the health ministry. India has also ramped up monitoring at all airports, and almost 8 lakh fliers have been screened. On March 4, the government announced that passengers from all nations would be checked for the virus. But questions have been raised about the credentials of the health team at the Guwahati airport as the health officer, Parthajyoti Gogoi, is not a doctor.

Guwahati provides a crucial link to the Northeast and it also has some international flights. It emerged on March 6 that Bhutan’s first Covid-19 case — a 76-year-old US tourist — had a week-long cruise on the Brahmaputra before he travelled to Thimphu, Bhutan’s capital.

Not just fliers but people who enter the country through land borders are also being checked for Covid-19. Uttar Pradesh alone has six border points with Nepal. As of March 5, more than 11.5 lakh people had been screened at border checkposts. About 4,000 meetings of village councils have been held to sensitise those living along the borders. Neighbouring states are also in constant touch with each other, given the frequent movement of people between them, says Kolandaswamy. Tamil Nadu shares a border with Puducherry, Andhra Pradesh, Karnataka and Kerala. Sarita RL, Kerala’s director of health services, did not respond to requests for comment.

The railways has also been roped in to augment the government’s efforts to disseminate tips on precaution. With 6,600 active stations across India, the railways is the largest public announcement network in India, explains VK Yadav, chairman of the Railway Board. Isolation wards are being created at each of the 84 railway hospitals.

While state governments might have suppressed information during a public-health crisis in the past, they cannot afford to do so now. The absence of verified communication gives space for rumours circulated on social media to grow.

Fortunately, politics has not come in the way of states working with the Centre or with each other on tackling the coronavirus infection. But that is small comfort in a country with just eight doctors per 10,000 people, compared with 18 in China. India has only nine beds per 10,000 people, while China has 38. ¡§Be prepared for the worst. While only a fraction would get sick if it spreads in a community, the absolute number of persons who need care would be large,¡¨ says Rajeev Sadanandan, a former Kerala bureaucrat who played a key role in handling the Nipah crisis.

India might not have the capacity to handle an outbreak of the scale China has seen. So its best bet is to prevent such an outcome.